Principles of Nasal Reconstruction after Mohs Micrographic Surgery
|
|
- Clement Wood
- 7 years ago
- Views:
Transcription
1 Principles of Nasal Reconstruction after Mohs Micrographic Surgery Francisco G. Pernas, MD Faculty Advisor: Vicente Resto, MD, PhD University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation March 31, 2o10
2 Outline History of nasal reconstruction Mohs surgery Nasal Anatomy/Terminology Reconstructive ladder Nasal Reconstruction Inner lining Framework Cutaneous defects
3 History of Nasal Mutilation Prince Lakshmana in India (1500 BC) Amputated nose of Lady Surpunakha King Ravana arranged for reconstruction Sushruta Samhita (700 BC) First detailed description of nasal reconstruction Involved use of a cheek flap Performed by caste of potters in India.
4 History of Nasal Reconstruction Italian Method: Developed by Antonious Branca Upper arm tissue transfer Revised by Benedetti and popularized by Tagliacozzi
5 History of Nasal Reconstruction Indian Method: Midline forehead tissue transfer
6 Mohs Micrographic Surgery Developed in 1930s by Dr. Federic Mohs Initially involved chemical fixation while tissue was still on patient. Today a fresh tissue technique is utilized. Less pain Benefits: Better cure rates Maximal tissue conservation Ability to trace perineural invasion Low cost (Operating theater vs. office procedure)
7 Mohs Micrographic Surgery Indications: Extensive recurrent skin cancers (did not respond to 1 tx) Unusually large primary skin cancers of long duration Poorly differentiated squamous cell carcinoma Morpheaform or fibrotic basal cell carcinoma Immune suppressed patient
8 Mohs Micrographic Surgery Indications: Tumors with poorly demarcated clinical borders Tumors on the face in locations where deeper invasion of the skin along natural skin planes is possible or the extent of the tumor is difficult to define, such as eyelids, nasal alae, nasolabial folds, and circumauricular areas Areas where maximum conservation of tumor-free tissue is important for preservation of function, such as the penis or finger
9 Mohs Future Trends Confocal laser scanning microscope Epidermis and part of dermis can be visualized based on different refractive indices of various structures in the skin, in vivo. Melanoma Use of Mohs technique in superficial melanoma (lentigo maligna and in situ melanoma) is still controversial. Clearly identifying melanoma cells in frozen horizontal sections is not always possible.
10 Mohs Micrographic Surgery
11 Mohs Surgery High risk anatomic areas Unclear if these areas provide fascial planes for spread. Studies have shown that these areas definitely tend to have more histologicaly aggressive tumors
12 Terminology
13 Septal Anatomy
14 Nasal Sidewall Anatomy
15 Nasal Anatomy Cartilaginous dorsum, upper lateral and alar cartilages frequently involved Often need soft tissue and structural reconstruction of defects
16 Tip Support Major tip support mechanisms: Scroll area Alar cartilages Medial crural attachment to caudal septum Septum
17 Introduction Nasal aesthetics: Nose provides smooth transition from eyes to lips Deformed nose disrupts facial harmony Nasal function: Disruption of normal anatomy can cause nasal obstruction, nasal drainage or impaired olfaction
18 Aesthetic Principles Replace tissue with like tissue Replace all missing components Restore units and aesthetics Evaluate tissue surrounding donor and recipient sites
19 Nasal Reconstruction What does the patient want? Expectations Patient Factors Health of patient, health of skin, smoker, etc. Diagnose the nasal defect Subunits, tissue layer, internal structures Evaluate donor materials for missing surface and tissue layers
20 Replace tissue with like tissue Cutaneous cover Local or regional flaps Full thickness skin graft Structural support Septal cartilage Auricular or rib cartilage Calvarial bone Lining flaps Septal mucoperichondrial flaps Vestibular or turbinate mucosal flaps
21 Facial Regions Divides face based: Concave vs. convex Relaxed skin tension lines Shadows. Attempt to hide scars at junction or along RSTL. Nose - region with subunits.
22 Restore units and aesthetics Nasal subunit principle: Nose divided by contour lines Zones of transition between nasal skin of differing texture and thickness. Subunits highlighted when light cast on nasal surface. Nasal framework primarily responsible for these variations in light reflections.
23 Restore units and aesthetics If greater than 50%, then best to excise and recon entire subunit. Takes advantage of trap door deformity to create buldge (convexity): Desired in dorsum, tip, alae. Fresh wounds enlarge use contralateral side to design template. Match color and texture.
24 Evaluate surrounding tissues Very thin skin Thickens as move caudally Thick sebaceous skin/fibrofatty tissue Dermis/dermis approximation Skin thinnest at rhinion Thickens as move caudally Thick sebaceous skin Columella: Thinnest nasal skin Supported by medial crura
25 Skin thickness
26 (Important in preventing contracture of wound)
27 Lining Flaps Bipedicled vestibular flap (Aka bucket handle flap) Make intercartilagenous incision between upper and lower lats Elevate the flap, sufficiently to mobilize Auricular cartilage can serve as framework to attach to. (must be defect <1.5cm in vertical height)
28 Lining Flaps Unilateral Septal Mucopericondrial hinge flap Sub-perichondrial dissection is completed from above downward towards the floor and from anteriorly to posteriorly Turn flap laterally as a hinge (Can measure up to 4-4.5cm in length and cm in width)
29 Lining Flaps Turbinate mucoperiosteal flaps Medialize the turbinate Create several small perforations along the length of the turbinate Finally fracture anteriorly Remove the bone from flap Transfer and secure into recipient location
30 Lining Flaps Septal composite chondromucosal pivotal flap Indicated for large full thickness defects of central nose
31
32 Framework Function is to provide contour and maintain a patent airway. Should be placed at time of reconstruction. Should resemble closely the shape, size and contour of missing parts. Help fix mucosal flaps in place prevent contracture.
33 Framework Cephalic Dorsum cranial bone. These are secured to frontal bone with miniplates. Caudal Dorsum septal or auricular cartilage. Lateral Sidewall may be replaced with bone or cartilage. Alar defects cartilage (usually contralateral concha cymba).
34
35 Nasal Reconstruction - Ladder Healing by secondary intention Dermabrasion Primary closure Full thickness skin grafts (FTSG) Composite grafts Random Flaps Pedicled Flaps
36 Secondary Intent Typically for medial canthal defects Results in contraction and distortion of nose Poor aesthetic outcomes on most defects of nose
37 Dermabrasion Limited to partial thickness defects Typically used after nasal reconstruction for refining scars Works best for sebaceous skin May be used on scars after complex recon
38 Types of Flaps: Defined by direction of tissue movement Advancement flaps: Linear movement Y-V advancement Rotational Flaps: Radial movement Transposition Flaps: Raised from donor sites and rotated over to defect Rhomboid, bilobed
39 Interpolated Flaps: Flap passed over or under bridge of skin separating site from defect: Island flap, Paramedian forehead flap. Important to recognize vectors of pull and force Especially when pulling from structures with low tensile strength such as the eyelid.
40 Local Flaps Advantages Excellent color and contour match Nearly 100% survival rate Easy wound care for patient Short healing period Disadvantages Technically more challenging Secondary defect may cause distortion More dissection & undermining = increased swelling, bruising, risk of hematoma Risk of trapdoor deformity (pin cushioning) Need for additional scars
41 Primary closure Little redundant skin on nose Easier on elderly patients Defect usually < 1cm Dorsum or sidewall May produce alar or tip distortions (rotation of tip).
42 Primary closure
43 Sidewall- Cutaneous Cover FTSG Transposition Flap Forehead Flap
44 Full Thickness Skin Graft Used instead of STSG to avoid contraction Need intact framework to support Use like tissue Best on younger patients with thin skin Best for nasal sidewall unit defects
45 Dorsum Cutaneous cover Glabellar Flap Forehead flap Primary closure FTSG
46 Glabellar Flap Single stage with good color and texture match Able to hide scar Not used if defects includes tip
47 Tip Lobule Cutaneous cover Bilobe flap Forehead flap FTSG
48 Tip Lobule Bilobe Flap Original design by Esser (1918) Modified by Zitelli Narrow angle of transfer Total transposition of 100 Ideal for defects: cm Best of 5mm from margin of nostril
49 Preferably laterally based Most common nasal local flap Double transposition flap Little distortion of alar rim
50 Columella Cutaneous cover FTSG (superficial) Composite graft (<1.5cm) Melolabial flap Forehead flap
51 Intermediate zone Cutaneous cover V-Y advancement flaps Small defects between the ala and tip Based off nasalis muscle and fat Defects <1.5cm Vascular supply from angular artery
52 Alar rim Cutaneous cover Melolabial flap Forehead flap Composite graft
53 Melolabial Interpolation Flap Preserves alar-facial sulcus Pedicle crosses sulcus and is taken down at 3 weeks Three types: Superiorly Based Lateral nasal wall, nasal ala Single stage Inferiorly Based Nasal sill and columella Island Pedicled flap Indicated for whole subunit alar surface replacement
54 Melolabial Interpolation Flap
55 Paramedian Forehead flap Based off supratrochlear artery cm lateral to midline Performed on same side of majority of defect Pedicle can be as narrow as 1.2cm Allows for greater arch of rotation Minimizes standing deformity
56 Paramedian Forehead Flap
57 Melolabial vs Forehead Melolabial Flap Smaller alar defect Lateral defect Cheek skin laxity Elderly No caregiver at home Must wear glasses Forehead Flap Larger alar flap Paramedian defect Tight cheek skin Younger patients Men with bearded cheek skin Smoker
58 Take home points Mohs Surgery Principles Reconstruction of Mohs Defects Cosmetic Principles Healing by Secondary Intent Skin Graft Primary closure Flap Reconstruction Reconstruction of specific locations
Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA
Traumatic Primary Eyelid and Facial Laceration Repair Riva Lee Asbell Philadelphia, PA I INTRODUCTION I always have to work a little harder when coding for traumatic eyelid and facial repairs. There is
More informationLip Cancer: Treatment & Reconstruction
Lip Cancer: Treatment & Reconstruction GBMC - Head & Neck Cancer Grand Rounds Elizabeth E. Redd, M.D. With the assistance of Ira Papel, M.D. Patrick Byrne, M.D. Lip Cancer: Treatment & Reconstruction Anatomic
More informationBlepharoplasty & Cosmetic eyelid surgery
Our cosmetic surgery team at The USF Eye Institute offers a wide variety of cosmetic procedures of the eyelids and face with the goal of obtaining a natural and rejuvenated appearance. Dr.Leyngold has
More information5 Upper eyelid blepharoplasty
5 Upper eyelid blepharoplasty INSTRUMENTS Marking pen No. 15 scalpel blade Blade handle Castroviejo needle holder Castroviejo calipers 0.5 fixation forceps Westcott scissors 6-0 prolene suture Bovie cautery
More informationAbdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S.
Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S. Global-HELP Publications Chapter Eight: TECHNICAL REQUIREMENTS FOR FORMATION OF A TUBED PEDICLE FLAP Creating a tube pedicle
More informationClaims submission simplified for emergency dental procedure codes
January 2002 No. 2002-02 PHC 1844 To: Dentists HMOs and Other Managed Care Programs Claims submission simplified for emergency dental procedure codes Effective immediately, both electronic and paper claims
More informationCoding Dermatology Procedures. Presented by: Betty A Hovey Director, ICD-10 Development and Training AAPC
Coding Dermatology Procedures Presented by: Betty A Hovey Director, ICD-10 Development and Training AAPC 1 No part of this presentation may be reproduced or transmitted in any form or by any means (graphically,
More informationOPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY NASOLABIAL FLAP FOR ORAL CAVITY RECONSTRUCTION Harry Wright, Scott Stephan, James Netterville Designed as a true myocutaneous flap pedicled
More informationMedical Necessity Guidelines: Reconstructive and Cosmetic Surgery
Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Effective: October 1, 2015 Clinical Documentation and Prior Authorization Required Coverage Guideline, No Prior Authorization Applies to:
More informationEvaluation of the Cosmetic Patient
APC Ophthalmology Conference Evaluation of the Cosmetic Patient David K. Isaacs, M.D. Clinical instructor Loma Linda University Clinial Staff Attending UCLA/Jules Stein Eye Institute Lecture Agenda Review
More informationMEDICAL MANAGEMENT POLICY
TITLE: Scar Revision/Keloid PAGE: 1of 9 This Medical policy is not a guarantee of benefits or coverage, nor should it be deemed as medical advice. In the event of any conflict concerning benefit coverage,
More informationMohs Micrographic Surgery
Mohs Micrographic Surgery Table of Contents Skin Cancer... What is skin cancer?... How is skin cancer treated?... Is skin cancer dangerous?... What are the causes of skin cancer?... How does skin cancer
More informationPHaSES: Practical Hands-on Surgical Education System
U.S. Toll Free 866-GOLIMBS PHaSES Range PHaSES: Practical Hands-on Surgical Education System Limbs & Things is pleased to introduce the PHaSES Range. The range is based upon our well known basic & general
More informationHow To Harvest Fat From The Infratemporal Fossila
Techniques in Cosmetic Surgery Harvesting Fat from the Infratemporal Fossa Bahman Guyuron, M.D., and Kevin Rose, M.D. Cleveland, Ohio As part of forehead rejuvenation and surgical treatment of migraine
More information(Immediate) Primary Versus Delayed Reconstruction of Human and Animal Bite
Egypt, J. Plast. Reconstr. Surg., Vol. 35, No. 2, July: 267-271, 2011 (Immediate) Primary Versus Delayed Reconstruction of Human and Animal Bite SAMY ELEOWA, M.D.; AHMED TAHA, M.D.; MOUSTAFA MEKY, M.D.
More informationMOHS MICROGRAPHIC SURGERY
Mary E. Maloney, MD Director Professor of Medicine David E. Geist, MD Assistant Professor of Medicine Dori Goldberg, MD Assistant Professor of Medicine Mark J. Scharf, MD Professor of Medicine Jason D.
More informationOklahoma Facts CPT. Definitions. Mohs Micrographic Surgery. What Does That Mean? Billing and Coding for Mohs Surgery
Billing and Coding for Mohs Surgery Cindy L. Wilson Dermatology Associates of Tulsa Oklahoma Facts Per square mile, Oklahoma has more tornadoes than any other place in the world. The highest wind speed
More informationWound Management and Basic Suturing Techniques. Disclosures
Wound Management and Basic Suturing Techniques 10 July 2016 Douglas Winstanley, DO FAAD FACMS West Michigan Dermatology Grand Rapids MI Hugh Greenway s 33 nd Annual Cutaneous Anatomy and Surgery Course
More informationReplacement of the upper left central incisor with a Straumann Bone Level Implant and a Straumann Customized Ceramic Abutment
Replacement of the upper left central incisor with a Straumann Bone Level Implant and a Straumann Customized Ceramic Abutment by Dr. Ronald Jung and Master Dental Technician Xavier Zahno Initial situation
More informationPhysicians as Assistants at Surgery: 2013 Study Participating Organizations:
Physicians as Assistants at Surgery: 2013 Study Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of
More informationFacial Sports Injuries
Facial Sports Injuries Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise
More informationMelanoma The Skin Understanding Cancer
Melanoma A form of cancer that begins in melanocytes (cells that make the pigment melanin). It may begin in a mole (skin melanoma), but can also begin in other pigmented tissues, such as in the eye or
More informationCurriculum Vitae. Darrell J. Fader, MD 1801 NW Market Street, Suite #107 Seattle, WA 98107 206-789-1177
Curriculum Vitae Darrell J. Fader, MD 1801 NW Market Street, Suite #107 Seattle, WA 98107 206-789-1177 EXPERIENCE ACADEMIC APPOINTMENTS 2001-Present Clinical Assistant Professor, Division of Dermatology,
More informationTHIRD BERGAMO OPEN RHINOPLASTY COURSE: From Fundamentals to Finesse
THIRD BERGAMO OPEN RHINOPLASTY COURSE: From Fundamentals to Finesse Course Directors: Enrico Robotti, Riccardo Mazzola FINAL PROGRAM Thursday March 1 07.15 Registration / Breakfast 07.50 Welcome and introduction
More informationThe interrupted horizontal
COVER ARTICLE OFFICE PROCEDURES The Mattress Sutures: Vertical, Horizontal, and Corner Stitch THOMAS J. ZUBER, M.D., Atlanta Medical Center, Atlanta, Georgia The interrupted vertical and horizontal mattress
More informationINTERNATIONAL MEDICAL COLLEGE
INTERNATIONAL MEDICAL COLLEGE Joint Degree Master Program: Implantology and Dental Surgery (M.Sc.) Basic modules: List of individual modules Basic Module 1 Basic principles of general and dental medicine
More informationTHE BEATIFUL FACE. Beauty. Esthetics. Beauty ESTHETICS LOCAL FASHIONS. Notion of beauty. Looking good. Orthodontics 2005
THE BEATIFUL FACE Orthodontics 2005 Malcolm E. Meistrell,, Jr., D.D.S. Clinical Professor of Dentistry Division of Orthodontics School of Dental and Oral Surgery Columbia University Beauty Beauty Esthetics
More informationUnilateral Nasal Polyps
Unilateral Nasal Polyps This tutorial follows on from the rhinosinusitis tutorial but only concerns itself with the unilateral nasal polyp. The majority of unilateral nasal polyps form in the same way
More informationFacial Nerve Paralysis: Management of the Eye
Facial Nerve Paralysis: Management of the Eye Facial Nerve Paralysis: Management of the Eye Introduction Anatomy Options Discussion of Literature Introduction-Facial Nerve Paralysis Functional and cosmetic
More informationPhysicians as Assistants at Surgery: 2016 Update Participating Organizations:
Physicians as Assistants at Surgery: 2016 Update Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of
More informationMinimally Invasive Spine Surgery
Chapter 1 Minimally Invasive Spine Surgery 1 H.M. Mayer Primum non nocere First do no harm In the long history of surgery it always has been a basic principle to restrict the iatrogenic trauma done to
More informationAnatomy PHL 212. By Dr Tajdar Husain Khan
Anatomy PHL 212 By Dr Tajdar Husain Khan Overview of Anatomy Anatomy(from the Greek word anatome,"dissection") is a branch of natural science dealing with the structural organization of living things The
More informationInformed Consent for Cosmetic Laser Skin Resurfacing with the DOT laser
Informed Consent for Cosmetic Laser Skin Resurfacing with the DOT laser INSTRUCTIONS This informed-consent document has been prepared to help inform you about laser procedure, its risks, as well as alternative
More informationOPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY
OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY SEPTOPLASTY FOR DEVIATION OF THE NASAL SEPTUM Ahmad Sedaghat, Benjamin Bleier Septoplasty refers to surgical manipulation and/or removal
More informationDefinition: A joint or articulation is a place in the body where two bones come together.
Definition: A joint or articulation is a place in the body where two bones come together. CLASSES OF JOINTS. 1. Joints are classified according to how the bones are held together. 2. The three types of
More informationB. Epidemiology 1. Geographic variation in incidence of non-melanoma skin cancer and malignant melanoma 2. Demographics of skin cancer
ACMS Core Curriculum I. BASIC SCIENCE A. Cutaneous Oncology 1. Theories of carcinogenesis 2. Current knowledge about epithelial carcinogenesis 3. Ultraviolet radiation - physics and clinical implications
More informationPressure Ulcers Assessing and Staging. Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010
Pressure Ulcers Assessing and Staging Anne Pirzadeh RN CWOCN University of Colorado Hospital June 2010 Never Events: Pressure Ulcers Pressure Ulcer Codes: MD documentation of pressure ulcers determines
More informationMOHS MICROGRAPHIC SURGERY
MOHS MICROGRAPHIC SURGERY UMass Memorial Medical Center 55 Lake Avenue North Worcester, MA 01655 (508) 856-1666 Dr. Mary Maloney This booklet is intended to explain Mohs surgery to you. It is not, however,
More informationUNMH Oral and Maxillofacial Surgery Clinical Privileges
All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 09/26/2014 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested.
More informationResection, Reduction, and Revision of Aneurysmal AV Fistulas
Resection, Reduction, and Revision of Aneurysmal AV Fistulas Patrick R. Cook DO, FACS Timothy G. Canty Jr. MD Robert J. Hye MD, FACS Kaiser Permanente San Diego, CA Aneurysmal AVF Over last decade K-DOQI
More informationBREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte TYPES OF IMPLANTS saline round implants high profiles low profile shaped
BREAST IMPLANTS (enlargement, augmentation) Dr. Benjamin Van Raalte has 20 years of experience with breast enlargement including axillary incisions and gel implants. Dr. Van Raalte is the first Quad City
More informationSurgery of the Frontal Sinus
Surgery of the Frontal Sinus Steven D. Pletcher MD Assistant Professor Department of Otolaryngology Head and Neck Surgery University of California, San Francisco Disclosures Co-author patent application
More informationLaparoscopic Hernia Repair. Hernia Repair. Laparoscopic Ventral. Several Different Types of Hernia
Laparoscopic Hernia Repair David B Renton, MD Assistant Professor Department of Surgery The Ohio State University Advantages of Laparoscopic Ventral vs. Open Hernia Repair Lower wound infection rate: 2.6%
More informationIntegumentary System Individual Exercises
Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this
More informationSurgery for Conductive Hearing Loss
Surgery for Conductive Hearing Loss What is conductive hearing loss Conductive hearing loss is a form of hearing loss due to abnormalities in mobile portions of the ear. Theses are the movable parts (including
More informationBreast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus
Breast Reconstruction Options Department of Plastic Surgery #290 Santa Clara Homestead Campus Importance of Breast Reconstruction As successes in treating breast cancer have grown, more women have been
More informationLesions, and Masses, and Tumors Oh My!!
Lesions, and Masses, and Tumors Oh My!! Presented by: Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC 1 1 CPT GUIDELINES Agenda CPT DEFINITIONS OP REPORT CASES 2 Definitions Cyst - a closed sac having
More informationSHOULDER INSTABILITY. E. Edward Khalfayan, MD
SHOULDER INSTABILITY E. Edward Khalfayan, MD Instability of the shoulder can occur from a single injury or as the result of repetitive activity such as overhead sports. Dislocations of the shoulder are
More informationAMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE. Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair
AMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE Eighth Edition 2012 Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair Essentials for Students Workgroup Lynn Jeffers, MD
More informationCongenital Anomalies In Diamond Blackfan Anemia (DBA)
Congenital Anomalies In Diamond Blackfan Anemia (DBA) CS217857 National Center on Birth Defects and Developmental Disabilities Division of Blood Disorders Congenital Anomalies In Diamond Blackfan Anemia
More informationScaphoid Fracture of the Wrist
Page 1 of 6 Scaphoid Fracture of the Wrist Doctors commonly diagnose a sprained wrist after a patient falls on an outstretched hand. However, if pain and swelling don't go away, doctors become suspicious
More informationOpen and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation
Plastic Surgery Open and Endoscopic Forehead Lift For All Brow and Forehead Lift Procedures Revolutionizing Soft-Tissue Fixation DESIGNED FOR SIMPLICITY AND PREDICTABILITY The versatile design can be applied
More informationYALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY
YALE UNIVERSITY SCHOOL OF MEDICINE: SECTION OF OTOLARYNGOLOGY PATIENT INFORMATION FUNCTIONAL ENDOSCOPIC SINUS SURGERY What is functional endoscopic sinus surgery (FESS)? Functional endoscopic sinus surgery
More informationCHAPTER 10 RESTS AND PREPARATIONS. 4. Serve as a reference point for evaluating the fit of the framework to the teeth.
CHAPTER 10 RESTS AND DEFINITIONS A REST is any rigid part of an RPD framework which contacts a properly prepared surface of a tooth. A REST PREPARATION or REST SEAT is any portion of a tooth or restoration
More informationHow To Improve Your Looks with Plastic Surgery
How To Improve Your Looks with Plastic Surgery By Daniel Becker Plastic surgery is a special type of surgery that involves both a person's appearance and his or her ability to function. Plastic surgeons
More informationEyelid Surgery - Lower
Eyelid Surgery - Lower Are your eyes still one of the most striking features on your face? Do they convey your actual emotions and inner vitality, or do they make you appear fatigued, sad, or older than
More informationMedical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8
Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan
More informationMelanoma and Other Skin Cancers - What to Look Out For. Patient Advice
Melanoma and Other Skin Cancers - What to Look Out For Patient Advice Most moles are healthy and will stay that way. Healthy moles tend to have the following appearances: Symmetry in shape and colour ie
More informationWide local excision. Delivering the best in care. UHB is a no smoking Trust
Wide local excision Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm This leaflet
More informationLid Surgery (Blepharoplasty)
Lid Surgery (Blepharoplasty) Blepharoplasty Blepharoplasty surgery involves the removal or redistribution of eyelid tissue. These tissues include skin, muscle and fat, all of which undergo changes with
More informationThis week. CENG 732 Computer Animation. Challenges in Human Modeling. Basic Arm Model
CENG 732 Computer Animation Spring 2006-2007 Week 8 Modeling and Animating Articulated Figures: Modeling the Arm, Walking, Facial Animation This week Modeling the arm Different joint structures Walking
More informationClarification of Terms
Shoulder Girdle Clarification of Terms Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus What is the purpose (or function) of the shoulder and entire upper
More informationOpen and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation
Plastic Surgery Open and Endoscopic Forehead Lift For All Brow and Forehead Lift Procedures Revolutionizing Soft-Tissue Fixation DESIGNED FOR SIMPLICITY AND PREDICTABILITY The versatile design can be applied
More informationYour Guide to Express Critical Illness Insurance Definitions
Your Guide to Express Critical Illness Insurance Definitions Your Guide to EXPRESS Critical Illness Insurance Definitions This guide to critical illness definitions will help you understand the illnesses
More informationUnderstanding Your Surgical Options For Breast Cancer
RADIATION THERAPY SYMPTOM MANAGEMENT CANCER INFORMATION Understanding Your Surgical Options For Breast Cancer In this booklet you will learn about: Role of surgery in breast cancer diagnosis and treatment
More informationFUNCTIONS OF THE SKIN
FUNCTIONS OF THE SKIN Skin is the largest organ of the body. The average adult has 18 square feet of skin which account for 16% of the total body weight. Skin acts as a physical barrier for you to the
More informationBelow is a diagram showing the main bones together with written text on their order of compilation.
Below is a diagram showing the main bones together with written text on their order of compilation. The hand and wrist contain twenty-seven bones and tendons, eight carpals, five metacarpals and fourteen
More informationGive us a table of facelift complications. How would you treat each? Answers from Cummings:
Give us a table of facelift complications. How would you treat each? Answers from Cummings: Hematoma The most common perioperative complication of rhytidectomy is hematoma, which occurs in 1% to 10% of
More informationAestheticare Cosmetic Surgery Institute Dr. Ronald E. Moser 30260 Rancho Viejo Rd. San Juan Capistrano, CA 92675 (800) 662-1055
Breast augmentation, or augmentation mammoplasty, is one of the most common plastic surgery procedures performed today. Over time, factors such as age, genetics, pregnancy, weight changes, sun exposure,
More informationADVANCED SUTURING WORKSHOP ANN BECKER, APRN-CNP; TONI PRATT-REID, APRN-CNP
ADVANCED SUTURING WORKSHOP ANN BECKER, APRN-CNP; TONI PRATT-REID, APRN-CNP SUTURING WORKSHOP! The technique of suturing, as a method for closing cutaneous wounds has been a part of medicine for hundreds
More informationAPPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE
Appendix DApril 1, 2015 PREAMBLE 1. Surgery to alleviate significant physical symptoms, which have not responded to a minimum of six months active treatment, or to restore or improve function to any area
More informationThyroid Eye Disease. Anatomy: There are 6 muscles that move your eye.
Thyroid Eye Disease Your doctor thinks you have thyroid orbitopathy. This is an autoimmune condition where your body's immune system is producing factors that stimulate enlargement of the muscles that
More informationMOHS MICROGRAPHIC SURGERY
MOHS MICROGRAPHIC SURGERY You have been referred to our office for Mohs Micrographic Surgery. Below are some frequently asked questions by patients undergoing Mohs Surgery. Please read through the questions
More informationClinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center
Printed Name Clinical Privileges Profile Plastic Surgery Indu & Raj Soin Medical Center Applicant: Check off the Requested box for each privilege requested. Applicants have the burden of producing information
More informationINJURIES OF THE HAND AND WRIST By Derya Dincer, M.D.
05/05/2007 INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D. Hand injuries, especially the fractures of metacarpals and phalanges, are the most common fractures in the skeletal system. Hand injuries
More informationPLASTIC SURGERY RESIDENTS HANDBOOK
PLASTIC SURGERY RESIDENTS HANDBOOK I. PLASTIC SURGERY REQUIREMENTS a. AACPS Post Interview Communication Guidelines b. General Competencies c. Plastic Surgery Goals & Objectives d. ACGME Required Index
More informationImplants in your Laboratory: Abutment Design
1/2 point CDT documented scientific credit. See Page 41. Implants in your Laboratory: Abutment Design By Leon Hermanides, CDT A patient s anatomical limitations have the greatest predictive value for successful
More informationTitanium Wire with Barb and Needle. For canthal tendon procedures.
Titanium Wire with Barb and Needle. For canthal tendon procedures. Technique Guide Instruments and implants approved by the AO Foundation Table of Contents Introduction Titanium Wire with Barb and Needle
More informationHair Design. 5 Elements of Hair Design. 5 Principles of Hair Design. Facial Shapes. Hair designs for men
Hair Design 5 Elements of Hair Design 5 Principles of Hair Design Facial Shapes Hair designs for men Elements of Hair Design To begin to understand the creative process involved in hairstyling, it is critical
More informationAnterior Lumbar Interbody Fusion (ALIF). Instrument set supports placement of ALIF spacers using anterior or anterolateral approach.
Anterior Lumbar Interbody Fusion (ALIF). Instrument set supports placement of ALIF spacers using anterior or anterolateral approach. Technique Guide Instruments and implants approved by the AO Foundation
More informationFOREHEAD, TEMPLE AND SCALP RECONSTRUCTION
FOREHEAD, TEMPLE AND SCALP RECONSTRUCTION H.D. Vuyk INTRODUCTION The forehead is a gently rounded, often smooth, area presenting certain reconstructive challenges. A large number of variables determine
More informationBreast Reconstruction Frequently Asked Questions
Breast Reconstruction Frequently Asked Questions GENERAL Do I need to have breast reconstruction? It is never medically necessary to have breast reconstruction. This is considered an elective procedure,
More informationPlastic Surgery Jewish General Hospital / Montreal General Hospital
Plastic Surgery Jewish General Hospital / Montreal General Hospital Structure of the Rotation Duration: Two weeks. Activities: Emergency Department consults Minor surgery Major surgery Plastics clinic
More informationPROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL
Oncoplastic breast conservation surgery Melvin J Silverstein C H A P T E R 5 Introduction Oncoplastic breast conservation surgery combines oncologic principles with plastic surgical techniques. But it
More informationLesions, and Masses,
Lesions, and Masses, and dtumors Oh My!! Presented by: Betty Johnson, CPC, CPC-I, CCS-P, PCS, CPC-H, RMC, CCP, CIC, CPCD and Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC 1 1 CPT GUIDELINES Agenda CPT
More informationPreputial Skin Grafts
11 Preputial Skin Grafts Ahmet Bulent Dogrul 1 and Kaya Yorganci 2 1 Mus State Hospital, Clinic of General Surgery, MUS 2 Hacettepe University Medical School, Department of General Surgery, Ankara Turkey
More informationDERMABOND Portfolio 2012 LACERATION REPAIR REIMBURSEMENT GUIDE
2012 LACERATION REPAIR REIMBURSEMENT GUIDE ETHICON, INC. IS PLEASED TO PROVIDE THIS LACERATION REPAIR REIMBURSEMENT GUIDE AS A RESOURCE FOR HEALTHCARE PROVIDERS. This guide is intended for informational
More informationProvided by the American Venous Forum: veinforum.org
CHAPTER 1 NORMAL VENOUS CIRCULATION Original author: Frank Padberg Abstracted by Teresa L.Carman Introduction The circulatory system is responsible for circulating (moving) blood throughout the body. The
More informationLymph Node Dissection for Penile Cancer
Lymph Node Dissection for Penile Cancer Exceptional healthcare, personally delivered Removal of Lymph Nodes Why are the Lymph Nodes so important when I have penile cancer? Lymph nodes are small bean shaped
More informationStructual Fat Transfer (Fat Injection to the Breast) Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust. Patient Information
Structual Fat Transfer (Fat Injection to the Breast) Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust Patient Information Introduction This information is for patients undergoing
More informationSuffering from varicose veins? Patient Information. ELVeS Radial Minimally invasive laser therapy of venous insufficiency
Suffering from varicose veins? Patient Information ELVeS Radial Minimally invasive laser therapy of venous insufficiency Do you suffer from heavy legs or visible veins? This makes diseases of the veins
More informationReLEx smile Minimally invasive vision correction Information for patients
ReLEx smile Minimally invasive vision correction Information for patients Seeing is living Our eyes are our most important sensory organ. The human brain obtains over 80 % of its information via the sense
More informationCosmetic Laser Procedures and Facial Contouring with Injectables. 2009, American Society for Aesthetic Plastic Surgery
Cosmetic Laser Procedures and Facial Contouring with Injectables Stuart B. Kincaid, MD, F.A.C.S. San Diego/La Jolla Office 8929 University Center Lane, Ste. 201 San Diego, California 92122 Phone: 858-450-4199
More informationCosmetic Surgery Procedures
Last Review Date: July 20, 2015 Number: MG.MM.AD.07cC2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth
More informationMohs Surgery Introduction. About skin cancer. What is Mohs surgery?
Phil Ecker, MD Clinical, Surgical & Cosmetic Dermatology Mohs Surgery Introduction Mohs surgery (also called Mohs micrographic surgery) is a specialized surgical treatment for skin cancer. Mohs surgery
More informationLUMBAR LAMINECTOMY AND DISCECTOMY. Basic Anatomical Landmarks: Posterior View Lumbar Spine
Lumbar Relating to the loins or the section of the back and sides between the ribs and the pelvis. In the spinal column, the last five vertebrae (from superior to inferior, L1-L5) Laminectomy Surgical
More informationbody breast augmentation
face body skin breast augmentation Rowena After years of self confidence issues and feeling out of proportion to the rest of my body, I felt I needed to make a change for me! breast augmentation considering
More informationSUMMARY A. GROSS ANATOMY OF SUPERFICIAL FASCIA AND
SUMMARY A. GROSS ANATOMY OF SUPERFICIAL FASCIA AND SUBCUTANEOUS FAT 1. Anatomy of Superficial Fascia: In this study, we observed that the superficial fascia of the abdomen was multilayered in the midline.
More informationBlepharoplasty - Eyelid Surgery
Blepharoplasty - Eyelid Surgery Introduction Eyelid surgery repairs sagging or drooping eyelids. The surgery is also known as blepharoplasty, or an eyelid lift. Sagging or drooping eyelids happen naturally
More information